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Sample Mediation Agreement

Nonprofit Insurance Program

Sample Mediation Agreement

NON-BINDING MEDIATION AGREEMENT

THIS AGREEMENT IS FOR NON-BINDING MEDIATION

Non-Binding Mediation

Due to the fact that lawsuits are costly and disadvantageous to both parties, the undersigned parties agree to submit to non-binding mediation to resolve any controversy between the parties, including but not limited to claims for professional negligence, personal injury, breach of an express or implied contract, loss of consortium, wrongful death, or any payment disputes. The mediation must be completed before the parties may submit to binding arbitration or other legal process.

Mediation Defined. Mediation is a non-binding process in which an impartial, trained, neutral third-party (the mediator), facilitates communication between the parties to a dispute in an effort to assist the parties in reaching a mutually acceptable and voluntary settlement of their dispute and to ensure that the parties memorialize whatever settlement they may have reached in a written settlement agreement.

Selection of Mediator. The parties will choose an acceptable mediator by mutual agreement. In the event that they cannot agree on a mediator, each party will select one mediator for the sole purpose of choosing a third mediator. The third mediator will mediate the claim.

Mediation Fees. The parties agree that all mediator fees and costs of mediation will be split evenly between them.

Representation by an Attorney. The parties may, but are not required to, be represented by their own attorney at the mediation. Each party will bear the cost of their own attorney associated with the mediation.

Parties Must be Present. The parties must appear in person at the mediation. The claimant agrees to appear in person. The company agrees that its representative who has full authority to settle the dispute will appear in person.

Confidential and Privileged Nature of Mediation Proceedings. By entering into the mediation process, the parties agree to maintain the confidentiality of the mediation with regard to all oral and written communications made during the course of the mediation. The mediation process will be treated as a compromise or offer to compromise or settle for purposes of the Federal Rules of Evidence and any applicable State Rules of Evidence. Nothing that occurs during the mediation process, nor any submissions made to the mediator, will be offered as evidence in any proceeding or investigation for any reason or purpose. Any and all discussions and/or statements made by the parties and/or the mediator regarding any settlement or its terms resulting from the mediation process will remain completely confidential and private. There will be no stenographic or other recording by any means of any portion of the mediation.

Agreement Memorializing Settlement Arising Out of Mediation. The parties agree that any settlement of the dispute resulting from the mediation will be memorialized in writing immediately upon completion of the mediation. Said written settlement agreement will be enforceable against the parties in a court of competent jurisdiction under the applicable state and federal laws.

Place of Mediation. The parties agree that the mediation of the claim will occur within the state where the nonprofit organization that is the subject of this dispute is located, and, where possible, within sixty (60) miles of the nonprofit organization.

Governing Law. The non-binding mediation portion of this agreement will be governed by the law of the state where the facility that is the subject of this dispute is located.

THIS AGREEMENT IS A LEGAL DOCUMENT AND ANY QUESTIONS OR CONCERNS ABOUT IT MAY BE DISCUSSED WITH LEGAL COUNSEL OF YOUR CHOICE.

I hereby agree to the dispute resolution procedure described above and its intent to provide administrative expedience. Its provisions have been explained to me and I have been provided the opportunity to ask questions about these provisions prior to my signature below. I understand that before I bring my claim to binding arbitration or other legal process, I must submit to this non-binding mediation.